Endoscopy 2012; 44(10): 905-910
DOI: 10.1055/s-0032-1310004
Original article
© Georg Thieme Verlag KG Stuttgart · New York

High-definition vs. standard-definition colonoscopy in the characterization of small colonic polyps: results from a randomized trial

G. Longcroft-Wheaton
1   Endoscopy, Queen Alexandra Hospital, Portsmouth, UK
,
J. Brown
2   Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
,
D. Cowlishaw
3   Histopathology, Queen Alexandra Hospital, Portsmouth, UK
,
B. Higgins
4   Department of Mathematics and Biostatistics, Portsmouth University, Portsmouth, UK
,
P. Bhandari
1   Endoscopy, Queen Alexandra Hospital, Portsmouth, UK
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Weitere Informationen

Publikationsverlauf

submitted 08. November 2011

accepted after revision 10. Mai 2012

Publikationsdatum:
14. August 2012 (online)

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Background and study aims: The resolution of endoscopes has increased in recent years. Modern Fujinon colonoscopes have a charge-coupled device (CCD) pixel density of 650000 pixels compared with the 410000 pixel CCD in standard-definition scopes. Acquiring high-definition scopes represents a significant capital investment and their clinical value remains uncertain. The aim of the current study was to investigate the impact of high-definition endoscopes on the in vivo histology prediction of colonic polyps.

Patients and methods: Colonoscopy procedures were performed using Fujinon colonoscopes and EPX-4400 processor. Procedures were randomized to be performed using either a standard-definition EC-530 colonoscope or high-definition EC-530 and EC-590 colonoscopes. Polyps of < 10 mm were assessed using both white light imaging (WLI) and flexible spectral imaging color enhancement (FICE), and the predicted diagnosis was recorded. Polyps were removed and sent for histological analysis by a pathologist who was blinded to the endoscopic diagnosis. The predicted diagnosis was compared with the histology to calculate the accuracy, sensitivity, and specificity of in vivo assessment using either standard- or high-definition scopes.

Results: A total of 293 polyps of < 10 mm were examined – 150 polyps using the standard-definition colonoscope and 143 polyps using high-definition colonoscopes. There was no difference in sensitivity, specificity or accuracy between the two scopes when WLI was used (standard vs. high: accuracy 70 % [95 %CI 62 – 77] vs. 73 % [95 %CI 65 – 80]; P = 0.61). When FICE was used, high-definition colonoscopes showed a sensitivity of 93 % compared with 83 % for standard-definition colonoscopes (P = 0.048); specificity was 81 % and 82 %, respectively.

Conclusions: There was no difference between high- and standard-definition colonoscopes when white light was used, but FICE significantly improved the in vivo diagnosis of small polyps when high-definition scopes were used compared with standard definition.